Care Home: Cherry Trees (Woking)

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What the care home does well The building was found to be clean, comfortable and well-maintained. Service provision was for eleven male adults with complex mental health conditions.The planned structure of the establishment`s management and operation observed to support a lifestyle that people using this service appear comfortable with. A person centred approach to planning individual programmes of support was evident, meaning the planning starts with the individual and not services. The care planning process observed to take account, so far as possible, the wishes and aspirations of people using the service. We found evidence of consistent programmes of care and support which promoted personal control, independence and responsibility. The wishes and interests of people using services were being accommodated within a flexible yet predictable structure of daily routines. Staff encourage people using this service to express themselves and to make informed decisions, enabling choice in their daily lives. Staff also support them to source further education and learning opportunities to develop social and employment skills. People using the service engage in peer and culturally appropriate social and leisure activities in the home and in the community. The staff team works collaboratively with professionals involved in the care and support of each person. Robust risk assessments and working protocols ensure people using this service have the level of support they need, promoting their health and wellbeing. Feedback received confirmed Cherry Trees management has earned credibility and respect of professionals, staff, the people using this services and their relatives. A senior health professional commented, " The home manages complex cases very well. All staff communicate brilliantly. It provides high quality care, is flexible, easy to contact, very professional and up to date, cost effective and undertakes one to one work with service users. I believe Cherry Trees to be a first class registered home. I myself refer my complex cases to the home due to the service they provide". Statements in surveys received from people using the service included, " The home does most things well but a lot of distraction from other clients and family involvement. I would like more things to do. I am very happy here but don`t like living just with men and sharing, but would be lonely at times. I would like to be living on my own and have transport". " I have been in tons of hostels and this is the best one ever. They do everything great." " They help me to do my own thing. I am happy here but would like to live on my own in a flat and to have a job one day". Relatives comments included, " We feel Cherry Trees is first class. Our relative is very happy living there and we are able to contact the manager or his staff at any time, should the need arise. We are always made most welcome when we visit". "They help my relative access other services like day centre, courses, voluntary work/part time work, to organise his bus pass, live within his budget, paying fines etc. Provide him with emotional support, treat him as a friend, brother or son not simply as a patient/client. Staff have helped him organise his life in terms of shopping and cooking, all are very positive and caring. They support him to decide short term and long term targets and encourage links with his family. Whenever I visit Cherry Trees the staff are friendly and very helpful. My relative is functioning very well and his mental health needs have really improved. He seems stable and happy achieved through consistent support from staff who provide him with stability and on-going support even when he experiences ups and downs. My family and I feel very grateful to the professional staff. They seem to have the appropriate balance of allowing him his independence whilst keeping a careful eye on how he manages his life. He previously found it difficult to live in the community. A big thank you". " I have found the care at Cherry Trees to be very good and know they have helped my relative. I know he needs supervision in many areas. He neglects himself and to encourage him to be mindful of his health and choice of good food, always bringing about the desired result." " They do everything well. I have nothing but praise for this incomparable hostel". What has improved since the last inspection? The upgrading and refurbishment work has included provision of another bedroom, increasing the registered numbers to twelve. The environment has been further enhanced by provision of good quality en-suite showers in bedrooms, floor coverings have been replaced in some areas, the kitchen has been upgraded and dining area redecorated. Fire doors have also been upgraded throughout the building. Policies, procedures and information about the home have been updated and new learning packages implemented for staff, relevant to the establishment`s purpose. What the care home could do better: We did not receive notifications of safeguarding incidents as required. Induction records for new staff should be signed off by the registered provider/manager. The storage, recording and disposal of staff Criminal Record Bureau (CRB) disclosures should be in accordance with CRB policy. Key inspection report Care homes for adults (18-65 years) Name: Address: Cherry Trees (Woking) Cherry Trees 15/17 Claremont Avenue Woking Surrey GU22 7SF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 2 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Cherry Trees (Woking) Cherry Trees 15/17 Claremont Avenue Woking Surrey GU22 7SF 01483829463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): cherrytreescare@ntlworld.com Mr Samy Kadoovel Gengasamy The registered provider is responsible for running the service care home 12 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 12 The registered person may provide the following category of service only Care home only (PC) to service users of the following gender: Either whose primary care needs n admission to the home are within the following category: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Cherry Trees is a service for male adults. Its aim is to support the people using this service to develop independent living skills and coping strategies to enable them to live in their own homes in the community. The premises comprises of two converted linked Victorian houses providing single occupancy bedrooms, most with en-suite shower facilities. An ongoing upgrading and refurbishment programme over recent years has Care Homes for Adults (18-65 years) Page 4 of 30 12 Over 65 0 Brief description of the care home enhanced the environment and created a modern, stylish home. Communal facilities include a large welcoming reception, two sitting rooms, a well - equipped kitchen and dining area, utility and visitors rooms and a computer/resource room. A small workshop and greenhouse is provided in the spacious garden. Cherry Trees is situated on a busy one-way road system within walking distance of Woking Town Centre. Limited parking space is available on the drive and metered parking available on the road. Weekly fees start at 650 pound. Additional charges may apply based on individual needs. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Last Key Inspection: 11th January 2007. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector over four hours. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgments about how well the establishment is meeting the National Minimum Standards for Adults (NMS). This includes accumulated evidence, knowledge and experience of the service since its last key inspection. We received an excellent response to a survey undertaken of stakeholders in this service. Survey questionnaires were received from nine people using the service, six from relatives, nine from health and social care professionals and six from staff. Care Homes for Adults (18-65 years) Page 6 of 30 Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. It provides quantitative information about their service and requires assessment of services against the NMS outcome areas, demonstrating areas of strength and where improvements can be made. The AQAA for Cherry Trees was received on time and its content was clear, of good quality and validated by evidence. The inspection visit was facilitated by both providers, one of whom is the designated registered manager. The process included discussions with three people using the service and two staff. We viewed two bedrooms and all communal areas including the garden. Direct and indirect practice observations were carried out and a range of records were sampled. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: The building was found to be clean, comfortable and well-maintained. Service provision was for eleven male adults with complex mental health conditions.The planned structure of the establishments management and operation observed to support a lifestyle that people using this service appear comfortable with. A person centred approach to planning individual programmes of support was evident, meaning the planning starts with the individual and not services. The care planning process observed to take account, so far as possible, the wishes and aspirations of people using the service. We found evidence of consistent programmes of care and support which promoted personal control, independence and responsibility. The wishes and interests of people using services were being accommodated within a flexible yet predictable structure of daily routines. Staff encourage people using this service to express themselves and to make informed decisions, enabling choice in their daily lives. Staff also support them to source further education and learning opportunities to develop social and employment skills. People using the service engage in peer and culturally appropriate social and leisure activities in the home and in the community. The staff team works collaboratively with professionals involved in the care and support of each person. Robust risk assessments and working protocols ensure people using this service have the level of support they need, promoting their health and wellbeing. Feedback received confirmed Cherry Trees management has earned credibility and respect of professionals, staff, the people using this services and their relatives. A senior health professional commented, The home manages complex cases very well. All staff communicate brilliantly. It provides high quality care, is flexible, easy to contact, very professional and up to date, cost effective and undertakes one to one work with service users. I believe Cherry Trees to be a first class registered home. I myself refer my complex cases to the home due to the service they provide. Statements in surveys received from people using the service included, The home does most things well but a lot of distraction from other clients and family involvement. I would like more things to do. I am very happy here but dont like living just with men and sharing, but would be lonely at times. I would like to be living on my own and have transport. I have been in tons of hostels and this is the best one ever. They do everything great. They help me to do my own thing. I am happy here but would like to live on my own in a flat and to have a job one day. Relatives comments included, We feel Cherry Trees is first class. Our relative is very happy living there and we are able to contact the manager or his staff at any time, should the need arise. We are always made most welcome when we visit. They help my relative access other services like day centre, courses, voluntary work/part time work, to organise his bus pass, live within his budget, paying fines etc. Provide him with emotional support, treat him as a friend, brother or son not simply as a patient/client. Staff have helped him organise his life in terms of shopping and cooking, all are very positive and caring. They support him to decide short term and long term targets and encourage links with his family. Whenever I visit Cherry Trees the staff are friendly and very helpful. My relative is functioning very well and his mental health needs have really improved. He seems stable and happy achieved through consistent support from staff who provide him with stability and on-going support even when he experiences ups and downs. My family and I feel very grateful to the professional staff. They seem to have the appropriate balance of allowing him his independence whilst keeping a careful eye on Care Homes for Adults (18-65 years) Page 8 of 30 how he manages his life. He previously found it difficult to live in the community. A big thank you. I have found the care at Cherry Trees to be very good and know they have helped my relative. I know he needs supervision in many areas. He neglects himself and to encourage him to be mindful of his health and choice of good food, always bringing about the desired result. They do everything well. I have nothing but praise for this incomparable hostel. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service are supplied with the information needed to decide whether the establishment is right for them. Comprehensive needs assessments are competently undertaken before admission to ensure needs and aspirations can be met. Good practice introductory admission procedures are followed and written terms and conditions of residency issued to people using the service. Evidence: There is a comprehensive statement of purpose and service users guide specific to Cherry Trees services and facilities. The importance of having sufficient information when choosing a care home is recognised by management. An up-to-date information pack about the home is issued to all prospective service users. The two care files we sampled evidenced admissions are well planned in advance. They are based on comprehensive needs assessments carried out with skill and sensitivity to ensure needs can be met. This process begins with the completion of a referral form by care managers and prospective service users supported by Care Programme Approach (CPA) documents and a psychosocial and medical history. The Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: provider/manager and a senior member of staff then assesses the individual in his own environment. Prospective service users are invited to the home for introductory visits and can phone and speak with staff if they need more information. Trial admissions are encouraged, forming part of the assessment process. All people using services receive a contract/statement of terms and conditions. A copy is also given to care managers before taking up placements. Survey feedback from people using services confirmed their satisfaction with pre-admission and admission procedures. All stated they had chosen to live at Cherry Trees. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence: Two current service users files were inspected. Support plans had been developed through the Care Programme Approach with the involvement of care management and the community mental health professionals. Plans were underpinned by the key principle that people using the service are in control of their lives, so far as practicable and direct the services received. There is strong emphasis on attainment of practical skills for independent living and self-sufficiency. The support plans viewed had been developed with and were owned by the individuals concerned, holistically addressing needs and diversity. Discussions with people using services also their survey feedback confirmed staff support them to lead purposeful, fulfilling lives as independently as possible. They are encouraged to make informed decisions and have the right to take risks. Support plans were regularly reviewed by staff also jointly with community mental health professionals and care managers.People using the service consulted Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: said they make their own decisions and can do what they want at all times of the day. They were aware of their rights and advocacy services are encouraged. They have a say on decisions that affect them in the day-to-day operation of the service.An example of the equity at the home was well demonstrated by their inclusion in staff meetings and in the staff recruitment process. Comments from professionals were all highly complimentary about standards and services at Cherry Trees. These included, The service is user focused, working with individuals at their own pace. It provides a homely setting and staff are very professional and supportive. They consider all needs including physical wellbeing. Staff are always available and willing to help, the environment is warm and welcoming. Relatives also highly commended the service. Comments included, They help my relative access other services like day centre, courses, voluntary work/part time work, to organise his bus pass, live within his budget, paying fines etc. Provide him with emotional support, treat him as a friend, brother or son not simply as a patient/client. Staff have helped him organise his life in terms of shopping and cooking, all are very positive and caring. They support him to decide short term and long term targets and encourage links with his family. Whenever I visit Cherry Trees the staff are friendly and very helpful. My relative is functioning very well and his mental health needs have really improved. He seems stable and happy, achieved through consistent support from staff. They provide him with stability and on-going support, even when he experiences ups and downs. My family and I feel very grateful to the professional staff. They seem to have the appropriate balance of allowing him his independence whilst keeping a careful eye on how he manages his life. He previously found it difficult to live in the community. A big thank you. I have found the care at Cherry Trees to be very good and know they have helped my relative. I know he needs supervision in many areas. He neglects himself. Staff encourage him to be mindful of his health and choice of good food, always bringing about the desired results. They do everything well. I have nothing but praise for this incomparable hostel. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services have opportunity to take part in a variety of social, leisure and educational activities at the home and in the community.They are supported in maintaining appropriate relationships with relatives and friends and encouraged to eat a healthy diet. Evidence: People using services consulted said staff and peers respect their privacy. They have been issued with a front door key, also bedroom keys and have lockable storage facilities in their rooms. There are agreed house rules to support individual privacy. Those wishing to bring home friends may do so after this has been agreed within their review process and after consultation with peers. Records evidenced internal and external opportunities available for personal growth Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: for people using the service. These are activated through agreed individualised support plans, Care Programme Approach (CPA) agreements and personalised activities programmes. Feedback from people using services confirmed their right to live an ordinary and meaningful life is central to Cherry Trees management and operation. The provider/manager has liaised with local businesses, employment facilitators, voluntary and training organisations in order to create employment and training opportunities for them. The activities some individuals engage in include voluntary work and adult education courses. The economic climate has had an adverse impact on employment opportunities. Social and leisure community activities enjoyed by individuals included attending football matches and using the local gym and leisure centre. The establishment is conveniently close to the town centre and its shops, cinema, library, pubs and cafes are frequently used. A workshop in the garden is used for various projects enabling people using services to learn practical life skills. Examples of these include bicycle maintenance, furniture renovation and gardening. We were informed that the home was mostly self-sufficient last year having grown vegetables from seed in the greenhouse which were later planted out. The resource room in the home has computers which are used by people using services and staff. Books, videos, a television and video recorder are also available. Service users in contact with family are supported to maintain appropriate relationships and friendships. Family members are welcomed and are part of a network of support available at Cherry Trees. People using services without family support can obtain the support of an independent advocacy service. Relatives who responded to our survey told us they are made welcome by staff. Comments included, We feel Cherry Trees is first class. Our relative is very happy living there and we are able to contact the manager or his staff at any time, should the need arise. We are always made most welcome when we visit. Their contact is supported according to individual choice and CPA agreements. People using services have freedom of movement with the exception of restrictions under the Mental Health Act. Survey feedback from people using services included these comments, The home does most things well but a lot of distraction from other clients and family involvement. I would like more things to do. I am very happy here but dont like living just with men and sharing, but would be lonely at times. I would like to be living on my own and have transport. have been in tons of hostels and this is the best one ever. They do everything great. They help me to do my own thing. I am happy here but would like to live on my own in a flat and to have a job one day. People using services agree responsibilities for domestic tasks in communal areas. They are also responsible for keeping their rooms clean and tidy and for personal Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: laundry. At the time of the visit the laundry room was clean and hygienic. They purchase their own food and supported with budgeting, shopping and cooking in accordance with their needs. The home has a hygienic, well-equipped combined kitchen/dining room. People using services can choose to cook and eat their meals at any time during the day up until 11.30 p.m. after which time they may prepare snacks. They eat their meals where they choose. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The current people using this service are mostly self-sufficient in respect of their personal care needs. The staff focus is mainly on provision of emotional and psychological support. Discussions with management and individual staff members confirmed they are alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond. People using services are encouraged to manage their own medical conditions, where feasible. Staff signpost them to appropriate services and provide the support needed to access services. Observations and information from people using services confirmed a person centred approach to personal and healthcare provision. Practice is based on rights of dignity, equality, fairness, autonomy and respect. All service users are registered with a general practitioner. Records evidenced access to relevant primary and specialist healthcare services.The staff team work in collaboration with health care professionals, mental health teams and with care Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: managers. This supports the physical and mental health wellbeing of people using services, enabling prompt referral to specialists in response to complications and problems. Feedback from professionals evidenced the homes substantial strengths and a sustained track record of high performance in meeting these standards. Some of the comments received included, Cherry Trees provides somewhere to live and grow for people with mental health problems. The client group has serious mental health problems, is difficult to engage in services and sometimes lead complex and chaotic lives. Cherry Trees provides an environment enabling stability and recovery. Staff are professional, always helpful and reliable. Despite the complex needs Cherry Trees is a safe home which is a testament to the skills of staff led by their managers. Difficult to fault the service. Though not the nearest to us it is the most trusted and respected. Good communication from manager. Good follow up from CPAs and appropriate action taken. Good links with local services. Skilled management and staff in the approach to managing and supporting social and health needs. The manager Samy is extremely good with service users. He sets high standards of care which the staff learn to adhere to. I have been very impressed with the level of respect and professionalism shown by the team at Cherry Trees. My client and his family are very happy with the service received. I wouldnt hesitate to recommend the home to other professionals. People using services are supported and encouraged to develop self-medicating skills. This includes obtaining prescriptions from their medical practice, taking these to the pharmacy and safe transfer of medication to their home. There are clear systems for checking and auditing medication. All of the people using the service have current self medicating risk assessments. They are at different stages in managing their own medication in accordance with their assessed needs. Some administer individual doses under staff supervision in the office or in their rooms where medication is securely stored. Both the service user and the staff member then sign medication administration records. Others administer their own medication without supervision and sign for receipt of supplies of their medication. The Community Psychiatric Nurse administers injections. Staff certificates evidenced they are trained in the management and administration of medication. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to express their concerns and have access to a robust and effective complaint and safeguarding procedure. Evidence: The home had a clear, accessible complaints procedure. The complaint and safeguarding policy and procedure were both reviewed this year. The complaint procedure is displayed in reception area and in the bedrooms viewed. Contact numbers have been issued to people using services for care managers, the CQC, consultant psychiatrists and general practitioners. Survey feedback from people using services confirmed they know who to speak to if they have concerns or complaints and are informed of how to make a complaint. No complaints had been received by the home in the past twelve months. The two people using services consulted during the visit stated they felt safe and are well supported by staff. They said their views were taken seriously and any issues raised were responded to. The home has a copy of the current multi-agency safeguarding adults procedure. This was followed in respect of three safeguarding adults referrals made since the last inspection. They had been investigated under the procedure and were now closed. We had not notified of two of the three incidents due to the provider/managers misconception that notification would take place under the multi-agency procedure. It was clarified this does not replace the legal obligation for notification to be made by registered persons. The records sampled evidenced staff working within the home are Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: fully trained to identify indicators of abuse; they also know how to respond in the event of receiving a safeguarding alert. There is a clear system for staff to report concerns about colleagues and managers. Discussions with people using services confirmed their involvement in decisions about any limitations on their choice. Systems are in place for the secure storage of personal finances and valuables. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services live in a safe, well-maintained and comfortable environment which is fit for purpose and promotes independence. Evidence: Observations whilst touring the premises confirmed the home to be clean and hygienic, comfortable and well maintained. An improvement programme over recent years has enhanced the environment, transforming the original two Victorian houses into a spacious, modern and stylish home. The tiled entrance hall is spacious and welcoming, containing potted plants, a piano and ornaments. Photographs recording the participation of people using services in various celebrations and pictures were displayed. The designation of communal space had been decided in consultation with people using the service. The outcome resulted in a room where they can meet with family and friends in private and a resource room with provision of computers, a television, video equipment and learning materials shared by staff and service users. Other improvements have created a more spacious lounge, upgraded and decorated the kitchen and dining area, refurbished bedrooms and made provision of good quality ensuite shower facilities in most bedrooms. Fire doors had all been upgraded this year, new television aerial points installed in bedrooms and another bedroom added. The Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: off-street parking space had been enlarged, a new television purchased and floor covering replaced in some areas. The provider/manager stated his intention to replace armchairs showing signs of wear and tear in the lounge. Developments for the next twelve months include plans for a sun-lounge and a new building in the grounds for providing of supported living accommodation. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practices are safe. The workforce is trained and competent and in sufficient numbers to support the homes stated purpose, meeting the needs of people using services. Evidence: The files of three staff were examined for the purpose of establishing how well the home is meeting these standards. We found staff had received clear job descriptions defining their roles and responsibilities and employment contracts. They were informed of and expected to conduct themselves in accordance with the General Social Care Council (GSCC) code of practice. People using services expressed confidence in the homes management and staff. Observations during the visit confirmed staff interaction with people using services was courteous and professional. Rotas demonstrated creative ways of ensuring the home is staffed efficiently in accordance with the changing needs of people using services. Staff receive flexible support and good direction from management. The provider/manager is present at the home five and sometimes six days a week. He lives locally and can respond promptly, day and night, if staff need assistance. The staff recruitment procedure is safe, clearly defining the process to be followed in compliance with statutory requirements. People who use the service are involved in Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: the recruitment process. Records evidenced new staff receive a relevant induction and all statutory training. A new learning package for staff has been implemented this year specific to the homes purpose and the needs of people using the service. Observations confirmed management support staff in their continuing professional development, preparing them for entry to the health and social care national vocational qualification(NVQ) programme. At the time of this inspection four permanent staff had achieved NVQ qualifications at level 2 or above. Staff are supported and supervised in their roles and responsibilities by the provider/manager whose career spans forty years as clinician and educationalist. Monthly staff meetings take place and people using services are invited to attend part of these meetings. Areas of discussion with management included the need for adherence with the Criminal Records Bureau (CRB) policy for the recording, storage and disposal of staff CRB disclosures. This shortfall was also raised at the time of the last inspection. The need to ensure staff induction records are signed off by the provider/manager, demonstrating competence across all six outcome areas was also identified. Feedback in staff surveys indicated good teamwork and staff morale. Staff feel valued and are well supported by management. They said they had received relevant training to perform their role and duties. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Visionary leadership and an open and inclusive management approach ensures the home operates and is managed in the best interests of people using the service. Their health, safety and welfare is protected and promoted by the homes policies, procedures and staff practice. Evidence: Since the last inspection there has been a change in the homes conditions of registration increasing the number of places to twelve. Though an amended certificate was posted to the home the old one was still displayed. The providers, who were both present throughout the visit, stated they had not received the certificate. It was agreed that a copy of the certificate would be reissued. The registered providers both work at the home, one is the designated full time registered manager and has managed the home for the past twenty two years. He demonstrated extensive relevant knowledge and experience. His management style was observed to be inclusive and empowering to both staff and people using the service. The other registered provider works at the home covering the deputy Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: managers duties when he has time off. Based on all available information it was evident that the management of this service has earned credibility and is highly respected by professionals, staff, people using services and their relatives and representatives. A senior health professional commented, The home manages complex cases very well. All staff communicate brilliantly. The home provides high quality care, is flexible, easy to contact, very professional and up to date, cost effective and undertakes one to one work with service users. I believe Cherry Trees to be a first class registered home. I myself refer my complex cases to the home due to the service they provide. Feedback from staff confirmed they receives strong direction and good management support. They feel the provider/manager is a good role model and professionals view him as an effective leader who consistently provides high quality services. The Annual Quality Assurance Assessment (AQAA) completed by the provider/manager was validated by evidence. It demonstrated understanding of the importance of equality and diversity. We found awareness and understanding of equal opportunities issues in the management and day-to-day operation of the service. This was evidenced by procedures and practice, records and stakeholders feedback. The AQAA gave examples of how the views of people using services have been used to shape the continuous development of services. The home has an effective quality assurance system, approved by a nationally recognised authoritative independent accredited body, Investors in People. It includes audits and an annual quality assurance survey of stakeholders. Health and safety audits are carried out and there is a planned maintenance programme. Since the last inspection fire doors had been upgraded, acting on a fire officers advice. Risk assessment processes and the missing persons procedure were both discussed during the inspection. It appeared that safe working practices promote the health, safety and welfare of people using this service. Areas for development and improvement discussed included the need for a protocol and procedure specific to The Mental Capacity Act 2005 deprivation of liberty safeguards. At the time of the visit staff were stated to have received awareness training of how this legislation affects their work. We were informed that none of the people using the service were subject to a deprivation of liberty authorisation or application. The need to ensure all notification are sent to the CQC was also discussed and for staff induction records to be signed off by the registered provider/manager. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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